Brief Answer:
ToRCH in pregnancy

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.


Toxoplasma :
On average, about one-third of all women who acquire infection with T. gondii during pregnancy transmit the parasite to the fetus; the remainder give birth to normal, uninfected babies. Of the various factors that influence fetal outcome, gestational age at the time of infection is the most critical.Women who are seropositive before pregnancy usually are protected against acute infection and do not give birth to congenitally infected neonates.
Toxoplasma. Positive IgG titers (>1:10) can be detected as early as
2–3 weeks after infection. These titers usually peak at 6–8 weeks and
decline slowly to a new baseline level that persists for life.IgM can persist for
>1 year and should not necessarily be considered a reflection of acute
disease.
Both IgG & IgM titers for Toxoplasma in your wife are declining -hence not indicating any acute infection.
Rubella :Pregnant women with a positive IgG antibody serologic test are
considered immune.A susceptible pregnant woman exposed to rubella virus should be tested for IgM antibodies and/or a fourfold rise in IgG antibody titer
between acute- and convalescent-phase serum specimens to determine
whether she was infected during pregnancy.
Both IgG & IgM titers in your wife for Rubella are declining -hence not indicating any acute infection.
Cytomegalovirus :
Cytomegalic inclusion disease develops in ∼5% of infected fetuses and is seen almost exclusively in infants born to mothers who develop primary infections during pregnancy
An increased level of IgG antibody to CMV may not be detectable for up to 4 weeks after primary infection. Detection of CMV-specific IgM is sometimes
useful in the diagnosis of recent or active infection.
Detection of viremia is however a better predictor of acute infection.The most
common method of detection is quantitative nucleic acid testing (QNAT) for CMV by polymerase chain reaction (PCR) technology,for which blood or other specimens can be used;some centers use 1193 a CMV antigenemia test, an immunofluorescence assay that detects CMV antigens (pp65) in peripheral-blood leukocytes.
CMV infection usually cannot be diagnosed reliably on clinical
grounds alone.
Unless your wife undergoes viral detection test,serology is inconclusive and cannot be taken as evidence of acute infection.
.
Herpes Simples Virus:
The risk of mother-to-child transmission of HSV in the perinatal period is highest when the infection is acquired near the time of labor—that is, in previously HSV-seronegative women.However, when women are seropositive for HSV-II at
the outset of pregnancy, no effect on neonatal outcomes (including
birth weight and gestational age) is seen.The acquisition of primary disease in pregnancy, related to HSV-2, carries the risk of transplacental transmission of
virus to the neonate and can result in spontaneous abortion, although this outcome is relatively uncommon.The high HSV-2 prevalence rate in pregnancy and the low incidence of neonatal disease (1 case per 6000–20,000 live births) indicate that only a few infants are at risk of acquiring HSV.
Moreover both IgG & IgM titers in your wife for HSV-IIare declining -hence not indicating any acute infection.
The position is she is not having any acute ToRH infection;hence treatment is not warranted to mother and there is no substantial risk of transmission to fetus.
As far as CMV infection is concerned she needs further tests as already mentioned before embarking on any treatment with antiviral drugs.
The answer contains many technical terms and details;however it can not be more simplified.







Regards

Dr. T.K. Biswas M.D. XXXXXXX

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